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Obstetric Quality and Safety

Poster Session 4

(1007) Racial Trends in Severe Maternal Morbidity in the US

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Racial disparities in severe maternal morbidity (SMM) are well known, however, data regarding temporal trends and regional variation are limited. We sought to evaluate these trends by race and ethnicity. 

Study Design: Retrospective cohort study of SMM using data from the National Inpatient Sample of US delivery hospitalizations (2010-2020). ICD9-10 codes identified SMM diagnoses as defined by the CDC (excluding transfusion). SMM rates by racial group (American Indian; AI; Asian and Pacific Islander; API; non-Hispanic Black; NHB; Hispanic; non-Hispanic White; NHW) were compared. Joinpoint regression determined annual percent change (APC) and average APC (AAPC) in SMM. Adjusted relative risk of SMM by region (Northeast; NE, Midwest; MW, South, and West) were ascertained using NHW (lowest SMM risk) as the referent group.

Results:

Of all US deliveries (2010-2020), the overall rate of SMM (per 100,000) was 673, 1183, 755, 811, and 999 among NHW, NHB, Hispanic, API, and AI cohorts respectively. SMM rate increased for all races (2010-2020 AAPC; NHB 2.3, CI 1.4-3.3, Hispanic 4.6, CI 3.3-6.2, API 2.8, CI 0.6-5.1, AI 3.8, CI 0.5-7.8) except NHW (AAPC -0.1 CI -0.8-0.7).  

NHW SMM APC increased significantly after 2017. NHB and API groups had significant APC increases beginning in 2018 while Hispanic APC increased significantly during 2010-2011 and again during 2017-2020. AI SMM APC was significant and constant throughout.  

SMM risk was higher in NHB compared to NHW parturients in the NE (aRR 1.8, CI 1.7-1.9), MW (aRR 1.7, CI 1.6-1.7), South (aRR 1.4, CI 1.3-1.4), and West (aRR 1.6, CI 1.5-1.6). SMM risk was likewise significantly higher for the Hispanic cohort (aRR range 1.1-1.4) in all regions except the South. For API, SMM risk was higher (aRR range 1.1-1.2) in every region outside the NE. AI had higher SMM risk (aRR range 1.1-1.2) in the NE and West but not MW and South.

Conclusion: All racial groups other than NHW had a significant increase in average APC of SMM (2010-2020). Significant regional and temporal variation in SMM exists between racial groups in the US.